Get Mi Bhs-ems-0092 2018-2025

Filling out the MI BHS-EMS-0092 form is an essential process for certifying insurance coverage for life support agencies. This guide provides clear and detailed instructions to assist you in completing the form accurately and efficiently online.

Follow the steps to complete the MI BHS-EMS-0092 form.

1. Click ‘Get Form’ button to obtain the form and open it in the online editor.
2. Enter the name of the insured or covered entity in the designated field. Ensure that this is accurately representative of the entity holding the insurance.
3. Fill in the address of the insured or covered entity, including city, state, and zip code. Verify that all details are correct to avoid any processing issues.
4. Under the insurance coverage section, provide the policy number, effective date, and expiration date. These details are crucial for confirming your insurance status.
5. Include bodily injury coverage for each crash and property damage coverage for each crash. Ensure these amounts meet the minimum coverage requirements as specified.
6. Indicate if you have a fleet policy by selecting ‘Yes’ or ‘No’. If ‘No’, attach a list of life support vehicles detailing year, make, type, and identification number.
7. Provide the name of the insurance company, agent's name, and agent's address, including city, state, and zip code.
8. Affix the signature of the authorized representative along with the date. Ensure that all entries are complete before proceeding.
9. Once you have filled in all necessary fields, you may save changes, download, print, or share the form as needed.

Complete your MI BHS-EMS-0092 form online today to ensure your life support agency is properly insured.